High-Frequency Skills Walkthrough (Checkpoint Mindset)

High-Frequency Skills Walkthrough (Checkpoint Mindset)

Quick Answer: Prepare Delaware skills list items (commonly labeled A–T in training materials) with a checkpoint mindset, not by copying entire official checklists into memory as prose. For every skill: hygiene → explain/privacy → locks/safety → skill-critical steps → comfort/call light → record if required. Emphasize measurement recording accuracy, privacy, and side safety (weak arm, strong-side pivot, side-lying supports).

This section is a teaching walkthrough, not the official Prometric/Delaware skill sheets. Always drill against the current Candidate Information Bulletin (CIB) checklists. Use the patterns below so any three computer-assigned skills feel familiar.

Universal Bookends (Repeat Silently Every Skill)

1. Hand hygiene; introduce; explain; privacy.
2. Gather supplies; raise bed if needed for body mechanics; lock brakes.
3. Gloves when body fluids or mucous membranes are involved.
4. Perform skill-specific critical steps.
5. Remove gloves; hand hygiene; comfort; lower/safe bed; call light; clean area; record measurements before “done.”

Mobility and Transfer

Ambulate with gait belt

Checkpoints: Explain; nonskid footwear; lock bed/chair as applicable; apply gait belt snug over clothing (two fingers under); assist stand; underhand grip on belt; walk slightly behind and to the side; match the resident’s pace; do not leave the resident standing alone; seat safely; remove belt; call light; hygiene.

If the resident begins to fall in practice, train the safe ease-down approach your program teaches (protect head, do not try to hold full body weight upright). On exam day, controlled safety beats heroic catching.

Bed to wheelchair pivot transfer

Checkpoints: Privacy; explain; wheelchair positioned on the strong side as scenario requires; both bed and wheelchair locked; remove or swing footrests; nonskid footwear; gait belt; resident scoots to edge; count and stand; pivot with feet/block as taught; lower to wheelchair center; hips back; feet on pedals if used; belt off; comfort; call light.

Fail traps: unlocked wheels, belt over bare skin, pivoting toward the weak side against instructions, and leaving the resident perched on the edge of the chair.

Elimination and Output

Bedpan

Checkpoints: Privacy; raise side rail opposite if needed for rolling safety per instructions; gloves; warm metal bedpan if facility practice applies; place bedpan correctly; cover resident; raise head of bed if allowed for comfort; provide toilet paper/wipes and call light while you step away if the skill requires privacy time; return; remove bedpan without contamination; peri clean as needed; dispose contents; remove gloves; hygiene; comfort; call light.

Empty urinary drainage bag and record I&O

Checkpoints: Gloves; keep drainage bag below bladder and off the floor during handling; open drain without contaminating the spout; empty into a clean graduate; close and secure drain; measure on a flat surface at eye level; record output in mL/cc on the I&O form accurately; remove gloves; hand hygiene before writing if that is your contamination sequence; report unusual color/odor/cloudiness to the nurse in real care (exam: follow skill recording rules).

Never estimate while holding the graduate in the air. Never include rinse water as urine.

Positioning and Linen

Supported side-lying (lateral) position

Checkpoints: Explain; privacy; lock bed; raise bed for mechanics then return safe height when done; use side rail for rolling safety as instructed; turn resident toward you with proper body mechanics; place supportive pillows (back, between knees/ankles, under upper arm as taught) so alignment is maintained; ensure dependent shoulder/hip are not crushed; call light; hygiene.

Occupied bed — change linens

Checkpoints: Privacy; gloves if linens soiled; roll resident side to side; keep resident covered for dignity and warmth; remove soiled linen away from uniform and without shaking; apply clean bottom linen tight and wrinkle-free; finish top linen and pillowcase; comfort; call light.

Wrinkles under the body are pressure-injury risks—smooth surfaces are a safety checkpoint, not cosmetic perfectionism.

Dressing and Personal Care

Dress resident with weak arm

Rule of thumb: Dress the weak arm first; undress the strong arm first. Support the weak side; never force a painful shoulder; provide privacy; choose clothing that fits the skill supplies; finish with comfort and call light.

Partial bed bath with back rub

Checkpoints: Privacy; water temperature check (inner wrist); wash clean to dirty; change water when soiled/cool per training; dry thoroughly; back rub with gentle circular/long strokes as taught unless contraindicated in scenario; gloves for peri areas if included; cover for warmth throughout; bed safe; call light.

Perineal care — incontinent female

Checkpoints: Privacy; gloves; expose only the perineum; wash front to back, top to bottom; clean portion of cloth for each stroke; separate labia; rinse and dry front to back; remove soiled briefs/pads without contaminating clean areas; new brief; remove gloves; hand hygiene; comfort.

Back-to-front wiping is a classic automatic fail because it tracks stool toward the urinary meatus.

Catheter care — female

Checkpoints: Privacy; gloves; front-to-back technique; hold catheter near meatus and clean away from the meatus along the catheter the required length; do not pull on the catheter; keep tubing free of kinks; drainage bag remains below bladder and off the floor; dry; remove gloves; hygiene; privacy restored.

Foot care

Checkpoints: Explain; comfortable position; water temperature check; soak only if the skill/checklist allows (diabetic precautions: follow CIB—many programs limit soaking); wash, rinse, dry between toes; never cut nails unless your official skill and training explicitly include it—Delaware foot care skills often focus on wash/dry/inspect/lotion on tops and bottoms not between toes as taught; report sores or discoloration; call light.

Hand and nail care

Checkpoints: Soak hands if allowed; clean under nails with orange stick as taught; file as directed (no aggressive cutting beyond skill scope); dry thoroughly; lotion; avoid lotion between fingers if your checklist restricts moisture there; infection control with shared equipment cleaned per instructions.

Mouth care — teeth

Checkpoints: Privacy; gloves; upright position to reduce aspiration; soft brush; brush all surfaces; allow rinse/spit with emesis basin; avoid stimulating gag aggressively; wipe mouth; report bleeding or sores; remove gloves; hygiene.

Denture care

Checkpoints: Gloves; line sink with towel/water to cushion if dropped; remove dentures carefully; brush all surfaces with appropriate cleanser (not necessarily regular toothpaste if checklist specifies denture cleaner); rinse thoroughly; store in labeled denture cup with water if not reinserting; reinsert if skill requires; oral mucosa check; hygiene.

Feed resident who is seated

Checkpoints: Hand hygiene; verify tray/name/diet as instructed; resident upright (~90°); sit at eye level; offer clothing protector; check food temperature; small bites; alternate solids/liquids at resident’s pace; ensure swallow before next bite; wipe mouth; leave upright after meal as aspiration precaution; record intake if required; call light.

Never feed a reclined resident. Never rush.

Measurement Skills

Radial pulse

Checkpoints: Explain; two or three fingers (never thumb) on thumb-side wrist; count per CIB timing (often full 60 seconds on skills exams); note rhythm/strength for real reporting; record the rate; stay within evaluator tolerance (commonly ±4 beats in Prometric-style scoring—confirm CIB).

Respirations

Checkpoints: Count without announcing “I am counting your breathing”; keep fingers on the wrist as if still on pulse so breathing stays natural; count full minute if required; record; tolerance commonly ±2 breaths—confirm CIB.

Recording accuracy is the skill. A perfect count that is never written, or written after contamination with gloved dirty hands, fails the purpose of the checkpoint.

Passive Range of Motion (ROM)

Delaware commonly tests passive ROM groupings such as elbow/wrist, shoulder, and hip/knee/ankle.

Checkpoints for all ROM skills:

• Explain; privacy; expose only the limb.
• Support the joint above and below.
• Move slowly and smoothly through flexion/extension, abduction/adduction, rotation, dorsiflexion/plantar flexion as the skill names.
• Perform the required number of repetitions (often three to five).
• Stop at pain or resistance—never force.
• Cover; comfort; call light; hygiene.

Forcing a joint is both an exam fail and a real injury risk. If the resident reports pain, stop that motion and report in real care; on exam, follow the critical stop rule.

Practice Strategy for A–T Coverage

1. Print or use the official list only—match letters A–T to your program’s current CIB.
2. Cycle three random skills daily plus handwashing.
3. Partner scores only checkpoints: privacy, locks, clean-to-dirty, weak side, recording, call light.
4. Video one measurement and one mobility skill weekly.
5. When you miss a checkpoint, redo the entire skill with the open/close routine—not just the missed motion.

Checkpoint mastery transfers across the list. That is how you walk into a computer-assigned trio without panic.